Tackling Access Barriers, In Three Languages

Monmouth Family Medical Center (MFMC) is located in Long Branch, NJ, a small city situated along the Jersey Shore, and a popular summer destination for those from the New York and New Jersey metro area as well as more local communities. The center’s main building is located across the street from the town beach in a working class section of the city, which stands in sharp contrast to Long Branch’s more prominent affluent communities. While Monmouth was first designated a Federally Qualified Health Center in 2004, it has served the Long Branch community as an outpatient arm of Monmouth Medical Center Hospital for over 30 years. The population served by the health center is one third Latino, one third African American, and the balance are Caucasian; 10% of the patients are Portuguese speaking. Since many of their patients have limited English skills, there are a number of employees that are trilingual, and speak English, Spanish and Portuguese. The center has established a strong reputation as a health care provider among the Latino immigrant community, a population that is overwhelmingly uninsured and often lacking the documents required in order to qualify for Medicaid. Over the past several years demand for community health services has grown and Monmouth’s patient population has more than doubled, due both to growing migration to the area and an increase, with the economic downturn, in the ranks of uninsured and unemployed.

I recently visited the center and was inspired by the staff’s passion and dedication to their patients. Marta Silverberg, CEO and Dr. Rashka Joshi, Medical Director, spoke to me at length about the various programs and strategies MFMC has implemented in order to provide the most successful and cost effective care possible for their patients. Dr Joshi emphasized the importance of active patient recruitment, systematic follow through with patients and effective record- keeping practices. All patients at Monmouth are either covered by the Medicaid program, the government insurance program for the very poor, or uninsured. A majority of these patients are recent Latino immigrants with limited English skills and many don’t have legal immigration status. These linguistic, economic and legal barriers among the patient population, pose unique challenges for the health care system. One of the biggest challenges is ensuring that patients receive the necessary follow up treatment and education about how to manage their own health. Most patients don’t understand how to navigate the complicated and bureaucratic medical system. In addition, many patients, especially those with chronic medical conditions such as diabetes, heart disease and asthma, need information about how lifestyle may impact their health. It is Monmouth’s responsibility to respond to these particular social determinants which significantly impact their patients’ health outcomes.

Dr. Joshi described how Monmouth has created an emergency diversion program which works closely with the hospital to identify patients who have used the Emergency Room for non-emergency conditions.It is Monmouth’s responsibility to respond to these particular social determinants which significantly impact their patients’ health outcomes. Intake specialists identify these patients and then immediately link them to Monmouth, to schedule appointments for primary care services. The center has set aside “open access appointment” slots specifically for patients who had visited the ER so that they can quickly obtain general check-ups. The program has been a simple but positive way to recruit and retain patients who are in need of primary care services, while providing care in a cost effective manner and ensuring that emergency resources are used appropriately.

The Center has also made strategic use of pre-natal visits to cover important cancer screenings and comprehensive preventative treatment and screenings. The majority of Monmouth’s female patients are not insured and many don’t come in for regular check-ups, missing out on essential screenings when they are unable to get to the center for routine care. Under Dr Joshi’s leadership, the medical team has implemented a protocol for providing pregnant patients with as many other required services and screenings as possible during the course of their prenatal visits. The center’s medical team has promoted prenatal services by hosting baby showers in the community, and holding events and programs at churches and housing projects. As part of an important study addressing ways to reduce and prevent disparities in infant mortality, they also provided post-partum physical exams, information about contraception options and screening for post partum depression. When needed, a case manager was assigned to the mother during both her pre- and post-natal visits. The case manager was in charge of follow up and reminding the patient about her upcoming appointments. Another part of the case manager’s responsibility was ensuring that the infants received their regular check-ups, screenings and immunizations as well as counseling about social and nutritional practices for the parent. Apart from the study, Monmouth has sought to develop creative ways to offer comprehensive care designed to meet the specific needs of the community. This holistic approach recognizes that the economic and social conditions that community health center patients face are in many ways the greatest potential barriers to health and must be taken to account when designing a health care model. Monmouth’s example highlights how health centers are truly embedded in their communities, and use their resources to expand not only access and scope of service, but indeed the general definition of what “health” is all about, in many languages.